Asthma Attack: What to Do, Signs to Watch For, and When to Call 999
How to recognise an asthma attack, the NHS steps for your reliever (including AIR and MART inhalers), when to call 999, how to tell it from a panic attack, and what to do afterwards.
Part of our asthma guide: symptoms, triggers and treatment.
Asthma attack? Get help now. Call 999 if your reliever isn’t helping, you’re too breathless to speak, eat or sleep, your breathing is getting faster, or your lips or fingertips are turning blue or grey. While you wait, sit up straight and take 1 puff of your blue reliever every 30 to 60 seconds, up to 10 puffs, through a spacer if you have one. If the ambulance hasn’t arrived after 10 minutes, repeat. Don’t complete an online consultation in an emergency.
Quick answer: An asthma attack is when your symptoms get worse quickly and your reliever isn’t helping as usual. Sit up straight. With a blue reliever, take 1 puff every 30 to 60 seconds, up to 10 puffs, through a spacer if you have one; with an AIR or MART inhaler, take 1 puff every 1 to 3 minutes, up to 6 puffs. Call 999 if you feel worse at any point, aren’t better after the maximum puffs, or don’t have your inhaler. Afterwards, see your GP within 2 days.
What Is an Asthma Attack?
An asthma attack is when your airways suddenly narrow much more than usual, making it hard to breathe. The lining of the airways swells, the muscles around them tighten, and they fill with extra mucus, all at the same time. The result is wheezing, breathlessness, chest tightness and coughing that your usual reliever doesn’t control.
Attacks range from mild, settling within minutes with your reliever, to life-threatening, needing oxygen, nebulisers and hospital treatment. Many build up over hours or days rather than coming on suddenly, so spotting the early signs gives you time to act.
For an overview of asthma, its symptoms and triggers, see our asthma guide.
Warning Signs of a Worsening Asthma Attack
Act early if you notice any of these:
- Your reliever is helping less, or you need it more often than every 4 hours
- Wheezing, coughing or chest tightness getting worse
- Waking at night with coughing, wheezing or breathlessness
- Too breathless to speak, eat or sleep, or breathing getting faster
- Peak flow falling below the level your action plan says to act on (often below 50% of your best)
Mild, Moderate and Severe: How to Tell the Difference
| Severity | Features | Action |
|---|---|---|
| Worsening asthma | More symptoms than usual; can talk normally; reliever helps; peak flow above about 75% of your best | Follow the amber zone of your action plan. See your GP or asthma nurse soon |
| Moderate attack | Increasing breathlessness; reliever helps less; peak flow about 50 to 75% of your best | Follow the attack steps below. Call 999 if you’re not better after the maximum puffs. If you settle, see your GP within 2 days |
| Severe attack | Can’t finish sentences; very breathless; reliever not working; peak flow about 33 to 50% of your best | Call 999. Keep using your reliever as below while you wait |
| Life-threatening | Exhaustion, drowsiness or confusion; blue or grey lips or fingertips; a “silent chest” (little or no wheeze because so little air is moving); peak flow below about 33% of your best | Call 999 immediately. Don’t wait. |
Peak flow ranges are the bands used in UK guidance for adults; your own action plan may use different figures, so follow it.
What to Do During an Asthma Attack: Step-by-Step
If you have a personal asthma action plan, follow it. Otherwise, the NHS advises, for a blue reliever:
1
Sit up straight and try to keep calm
Don’t lie down. If you’re helping someone else, stay with them and reassure them.
2
Take 1 puff every 30 to 60 seconds, up to 10 puffs
Use a spacer if you have one, and shake the inhaler between puffs. With a spacer, take a few breaths in and out through it after each puff.
3
Call 999
If you feel worse at any point, you don’t feel better after 10 puffs, or you don’t have your inhaler. Tell them it’s an asthma attack, and if you’re pregnant.
4
If the ambulance hasn’t arrived after 10 minutes, repeat step 2
Take up to 10 puffs again in the same way. Don’t drive yourself to A&E.
5
Afterwards, see your GP within 2 days
Even if you feel better, get an urgent appointment with your GP or asthma nurse, as the NHS advises. An attack is a sign your treatment needs reviewing.
Call 999 immediately if: you feel worse at any point · you’re not better after the maximum puffs · you don’t have your inhaler · you can’t speak in full sentences · lips or fingertips are turning blue or grey · you’re drowsy, confused or exhausted · a child stops breathing, even briefly.
If You Use an AIR or MART Inhaler
If your reliever is a combination inhaler containing a steroid and formoterol, such as Symbicort, used as AIR (anti-inflammatory reliever) or MART (maintenance and reliever therapy), the NHS steps are different:
- Take 1 puff every 1 to 3 minutes until you feel better, up to 6 puffs
- Call 999 if you feel worse at any point or aren’t better after 6 puffs
- If the ambulance hasn’t arrived after 10 minutes, take up to 6 puffs again in the same way
- Follow your action plan if it gives a different maximum
Our asthma inhalers guide explains how AIR and MART work.
Using Your Inhaler and Spacer During an Attack
A spacer gets much more medicine into your lungs than an aerosol inhaler alone, which matters most when you’re struggling to breathe. Put one puff into the spacer at a time, breathe it in, then take the next puff. A blue reliever through a spacer works as well as a nebuliser for most attacks.
Breath-actuated inhalers (such as Easi-Breathe and Autohaler types) and dry powder inhalers can’t be used with a spacer, and dry powder inhalers need a strong breath in, which can be hard during an attack. If you have a standard aerosol reliever such as Ventolin Evohaler and a spacer, keep them where you can reach them. Our guide to how to use an asthma inhaler shows the spacer technique.
When to Call 999
Many people put off calling 999 because they worry they’re overreacting. Don’t wait if:
- you feel worse at any point, or aren’t better after the maximum puffs of your reliever
- you don’t have your inhaler with you
- you’re too breathless to speak in full sentences, eat or sleep
- lips or fingertips are turning blue or grey, a sign of dangerously low oxygen
- you’re drowsy, confused, exhausted or losing consciousness
- the chest has gone quiet (a “silent chest”), meaning very little air is moving
- a child stops breathing, even briefly
Asthma Attack vs Panic Attack: How to Tell
Both cause sudden breathlessness and anxiety, and one can set off the other, so they’re easily confused:
| Asthma attack | Panic attack | |
|---|---|---|
| Sound | Wheeze (whistling, especially breathing out) | Usually no wheeze |
| Breathing | Hard to breathe out; chest feels tight | Fast, shallow breathing (hyperventilation) |
| Reliever inhaler | Usually helps within minutes | No direct effect |
| Other symptoms | Chest tightness, cough | Tingling in fingers or around the mouth, dizziness, racing heart |
| Triggers | Colds, allergens, cold air, exercise, smoke | Stress, anxiety, or no clear trigger |
| If unsure | If you have asthma, use your reliever as your action plan says. It’s unlikely to do harm, and get help if you don’t improve | |
If breathlessness keeps happening without wheeze or a clear asthma trigger, mention it to your GP; breathing pattern problems are common and treatable. Our guide to Ventolin for shortness of breath covers other causes.
After an Asthma Attack: What Happens Next
After any attack, even one that settled at home, see your GP or asthma nurse within 2 days. An attack means your asthma isn’t controlled, and your treatment may need changing. They’ll check:
- whether you need a short course of steroid tablets to settle the inflammation
- your inhaler technique and whether you’re taking your preventer as prescribed
- whether your treatment should be stepped up, for example to MART
- what triggered the attack, and whether your action plan needs updating
If you were treated in hospital, you should also have a follow-up after discharge. Make sure you have enough reliever and preventer at home.
Your Asthma Action Plan
UK guidance says everyone with asthma should have a personalised written or digital asthma action plan, agreed with their GP or asthma nurse. Most use three zones:
| Zone | What it means | What the plan tells you |
|---|---|---|
| Green | Asthma under control | Your daily medicines and doses, and your usual peak flow |
| Amber | Asthma getting worse: more symptoms, waking at night, needing your reliever more, peak flow falling | What to change (for example extra doses), and when to contact your GP |
| Red | An asthma attack | The reliever steps above, and when to call 999 |
Keep a copy on your phone and somewhere family or colleagues can find it. If you don’t have a plan, or yours hasn’t been updated since your treatment changed, ask for one at your next review.
Reducing Your Risk of Future Attacks
- Take your preventer every day, even when you feel well; it keeps airway inflammation down. See our preventer inhaler guide.
- Have an asthma action plan and keep it up to date.
- Have a review at least once a year, and after every attack.
- Know your triggers: see our asthma triggers guide and autumn asthma guide.
- Get vaccinated: colds, flu and COVID-19 are the most common triggers of severe attacks; most adults with asthma who use a steroid inhaler can have a free NHS flu vaccine.
- Carry your reliever at all times, and know how many puffs are left: count puffs if your inhaler has no dose counter.
- Watch for warning signs: needing a blue reliever more than twice a week, or 3 or more reliever inhalers a year, means your asthma needs a review.
Who our online service is for. Access Doctor supplies asthma and COPD inhalers to adults aged 18 and over who already have a diagnosis, for the same inhaler, strength and dose they’re prescribed now, and we share the consultation with your GP. We can’t diagnose asthma or start or change treatment online. Children’s inhalers are managed by their GP or asthma nurse.
Safety, your GP and free NHS options
Asthma inhalers are prescription-only medicines in the UK. Before anything is supplied, a GPhC-registered pharmacist independent prescriber reviews your consultation, including the other medicines you take; some, such as beta-blockers, can make asthma worse.
- Relievers on their own: since 2024, UK guidance (NICE, BTS and SIGN) says adults with asthma shouldn’t be treated with a reliever alone, and in April 2025 the MHRA reminded prescribers not to supply one without an inhaled steroid. If you don’t use a preventer, we can supply a reliever once and will ask you to see your GP or asthma nurse.
- How many: up to 2 reliever inhalers per order. If you’ve needed 3 or more in the last 12 months, we’ll ask you to have an asthma review first; needing that many is linked to a higher risk of severe attacks.
- Read the leaflet in the pack, and ask a pharmacist or asthma nurse to check your technique.
- Report side effects to a pharmacist or doctor. You can also report them to the MHRA through the Yellow Card scheme.
We share your consultation with your GP because asthma needs ongoing care. Access Doctor is a private service, and there are free NHS options:
- Your GP practice: asthma reviews (at least once a year) and repeat prescriptions; many practices let you order repeats through the NHS App.
- Prescription charges: NHS prescriptions are free in Scotland, Wales and Northern Ireland. In England a charge applies unless you’re exempt, and a prepayment certificate can save money if you need several items.
- Urgent advice: NHS 111 (NHS 24 on 111 in Scotland), or 999 in an emergency.
Need Your Usual Inhaler?
Access Doctor is a GPhC-registered pharmacy (#9011198). If you’re an adult with diagnosed asthma or COPD, a pharmacist independent prescriber reviews your online consultation and supplies your usual inhaler if it’s safe, and we let your GP know. Approved before 3pm, Monday to Friday? Dispatched the same day, by Royal Mail Tracked 48, Tracked 24 or Special Delivery guaranteed by 1pm next working day: you choose. Delivery is free on orders over £40.
Start Asthma Consultation →Frequently Asked Questions
What should I do during an asthma attack?
Sit up straight and try to keep calm. If you use a blue reliever, take 1 puff every 30 to 60 seconds, up to 10 puffs, through a spacer if you have one. If you use a combination inhaler as AIR or MART, take 1 puff every 1 to 3 minutes, up to 6 puffs. Call 999 if you feel worse at any point, you don’t feel better after the maximum puffs, or you don’t have your inhaler. If the ambulance hasn’t arrived after 10 minutes, repeat the puffs. Follow your asthma action plan if it says something different.
When should I call 999 for an asthma attack?
Call 999 if your reliever isn’t helping, you feel worse at any point, you don’t feel better after the maximum puffs, or you don’t have your inhaler. Call straight away if you’re too breathless to speak, eat or sleep, your lips or fingertips are turning blue or grey, you feel drowsy or confused, or a child has stopped breathing, even briefly. A severe asthma attack is a medical emergency.
How long does an asthma attack last?
It varies. A mild attack may settle within minutes of using your reliever. A severe attack needs emergency treatment and can take hours to bring under control, and symptoms can take days to settle fully. Attacks often build up over a day or two before they become severe, which is why worsening symptoms need acting on early. After any attack, even one that settled at home, see your GP or asthma nurse within 2 days.
Is an asthma attack the same as a panic attack?
No, but they can be hard to tell apart because both cause breathlessness and anxiety, and one can trigger the other. Asthma attacks usually cause wheeze, chest tightness and cough, and improve within minutes with a reliever. Panic attacks tend to cause fast, shallow breathing, tingling in the fingers or around the mouth, and dizziness, without wheeze. If you have asthma and aren’t sure, use your reliever as your action plan says, and get help if you don’t improve.
Can you die from an asthma attack?
Yes. Asthma attacks can be fatal, but most deaths are thought to be preventable. The UK’s National Review of Asthma Deaths found widespread over-reliance on reliever inhalers and under-use of preventers among people who died, and nearly half had not had an asthma review in the year before. Taking your preventer as prescribed, having a written action plan, getting a review after every attack, and knowing when to call 999 all reduce the risk. See our preventer inhaler guide.
What causes a severe asthma attack?
Severe attacks are most often set off by colds and other viral chest infections, allergens (house dust mites, pollen, pets, mould spores), air pollution, smoke, cold air, or some medicines such as anti-inflammatory painkillers in people sensitive to them. Not taking a preventer regularly is a major factor: when the airway inflammation isn’t controlled, the airways react far more strongly to triggers. See our asthma triggers guide.
What is an asthma action plan?
A written or digital plan, filled in with your GP or asthma nurse, that says what to take every day, how to recognise when your asthma is getting worse, what to do then (for example extra doses or starting steroid tablets), and when to get emergency help. Plans often use green, amber and red zones based on symptoms or peak flow. UK guidance says everyone with asthma should have one. Ask for yours at your next review.
Should I tell 999 if I’m pregnant?
Yes. Treat an asthma attack in pregnancy exactly as you would at any other time, and tell the 999 call handler and the ambulance crew that you’re pregnant. Don’t hold back on your reliever: a severe attack is far more dangerous for you and your baby than the medicine. See our asthma in pregnancy guide.
For symptoms, triggers and how asthma is diagnosed, see our asthma guide.
References
- NHS. Asthma attack. nhs.uk
- NICE, BTS and SIGN. Asthma: diagnosis, monitoring and chronic asthma management (NG245), November 2024. nice.org.uk
- MHRA Drug Safety Update. Short-acting beta-2 agonists (SABA): reminder of the risks from overuse in asthma and changes in the SABA prescribing guidelines, April 2025. gov.uk
- Royal College of Physicians. Why asthma still kills: the National Review of Asthma Deaths (summary for patients and the public), 2014. rcp.ac.uk
- Asthma + Lung UK. Completing an asthma action plan with your patients. asthmaandlung.org.uk
- Asthma + Lung UK. Asthma attacks. asthmaandlung.org.uk
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for diagnosis and treatment. In a medical emergency, call 999.